Source: www.theguardian.com
One of the most commonly fought over topics between healthcare workers and their patients is the unwillingness of patients to take their prescribed medicines.
The degree of non-adherence varies from patient to patient; ranging from those who completely refuse to ingest any of the funny coloured pills their doctor has prescribed to them, to those that take everything their doctor prescribed, but slightly less than what they’re supposed to.
In my experience as a pharmacist, there are several reasons that patients often put forward to explain this behaviour. Some will say that they don’t believe in unnatural substances while some will say that the body will heal itself naturally. Others may claim a fear of the potential side effects, which in my opinion is a valid complaint, considering the regulatory requirement for manufacturers to list down every single possible side effect even if the chance of it occurring were one in a million. Some patients on the other hand, have suffered a side effect or two from other medication and thus have developed a sense of fear towards medicines. Other patients have also shifted the blame to external factors, citing their busy lifestyle, their children, their parents, their spouses, their bosses, their work and even the weather as a reason why they do not take their medicines as prescribed. Lastly, there are sadly those who simply cannot afford to buy the medicines that have been prescribed.
Frustrated healthcare professionals often have their own less-than-complimentary theories explaining why patients don’t take their medicines as prescribed. I must hastily add right now that I oppose to this notion. I believe the root of the problem lies elsewhere. But before that, let’s get one thing straight: A patient that doesn’t take their medicine isn’t a bad patient. He or she isn’t stupid, irresponsible or morally corrupt. He or she isn’t trying to single-handedly undermine your expertise or throw bricks at the magnificent institution of allopathic medicine. A patient that doesn’t take their medicine simply doesn’t trust their healthcare provider (yet) or has fears about their prescribed treatment.
Source: qualitymedications.net
So what is the problem, then?
Despite the wide variety of reasons being thrown about to explain this problem, I would like to put forward the idea that there are three main problems that results in non-adherence to prescribed medicine. The problems are the lack of trust, the feeling of fear and the lack of communication.
The lack of trust leads to non-adherence when patients feel they cannot trust the unnatural substances that some person in a white coat has just ordered them to take, without much explanation. Lack of trust arises when any small amount of explanation is made using jargon and terms that sound alien, clinical and frightening. Lack of trust takes root when at the end of an incomprehensible explanation, a subtle threat is added, promising dire consequences and sometimes death, if the instructions given are not obeyed. Trust between a patient and their healthcare provider also rears its ugly head when, having discovered long, frightening lists of side effects, the concerns of the patient are dismissed with nary an explanation. In the eyes of a suspicious patient, the doctor that does not explain appears to be a doctor with something to hide.
From the lack of trust, comes fear. Fear compounds the problems that arise from the loss of trust between a healthcare provider and his patient. Fear of side effects and toxicity leads patients to stop taking their medicines. Fear of the unknown leads patients to search more, often finding more frightening and incomprehensible information in the process. Fear of a doctor’s wrath causes patients to pretend that everything is okay and mislead their doctors into thinking that they’re taking their medicines obediently. Fear drives patients to make hopelessly misguided decisions, often either completely rejecting all forms of treatment or trying every possible treatment at once. This is often not without dire consequences for the health of the patient. Fear, therefore, leads to self-harm.
Source: www.theguardian.com
So where does fear and this lack of trust come from?
I believe it comes from the lack of communication.
Both patients and healthcare providers need to sit down and communicate their desires, their goals and their concerns regarding the health of the patient and the proposed treatment plan. Patients need to speak out about what they want their doctors to achieve for them and what their fears; problems and other external factors than can affect their treatment. Healthcare providers need to provide patients with an opportunity to speak as well as the full commitment to listen with an open mind. A patient who cannot adhere to a prescribed medication regimen because of his busy work schedule needs very different help from a patient who cannot adhere because she has deep-seated fears about how the medication will affect her fertility. Healthcare providers must allow patients to communicate these concerns, take them into sincere consideration and effectively communicate back the facts in a frank and effective manner.
Patients must also allow their healthcare providers to communicate to them their objectives for the prescribed treatment, the potential complications as well as their reasoning for why a particular treatment was chosen. Patients need to be able to take in these information with an open mind, without allowing suspicion and paranoia to immediately reject what their healthcare provider is saying. Patients also need to allow the fact that a healthcare provider who cannot immediately provide all the facts isn’t necessarily trying to hide something or is incompetent. For the most part, healthcare providers are in the business of getting patients back to a healthy state. Patients should also not fear their healthcare providers and should be frank in voicing their concerns regarding their prescribed treatment. More often than not, alternatives can be found if a particular treatment does not sit well with the patient. By keeping silent, the only thing that is achieved is harm for the patient.
In summary, non-adherence to prescribed medical treatment is a major issue that results in huge financial costs and poor clinical outcomes. The lack of trust, fear and, lack of communication between patients and their healthcare providers is often the main reason for non-adherence. Both patients and healthcare providers need to work on communicating with each other in order to align both their objectives and concerns in order to achieve the desired therapeutic outcomes.
This is the personal opinion of the writer and does not necessarily represent the views of The Malaysian Medical Gazette.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]
Hello…
Someone I knew recently passed away in an accident. I was told he fell from his motorcycle on the way to work. It’s only after his death, I knew he was prescribed alprazolam since December 2013. I read online, may I ask… does alprazolam cause drowsiness?
Still, I’m not writing to wonder if his accident is related to the prescription. I am here simply to say & wish, rather than he was prescribed alprazolam… the doctor would have told him about other ways to manage himself. Maybe… he could have meditated, strengthen relationships etc. Personally to me, the alprazolam shouldn’t be a magic pill – his body & his life is so much more than that. That is why I wish medicine will be more holistic – is that the word? – than just prescribing medicine.
I hope doctors will consider my opinion, pls forgive me if I err or anything.
Yes if his doctor asked me, I wish he was prescribed lotsa love & hugs from his family than alprazolam.
Wonderful piece, Mr Mark.
I also notice some patients do not take their meds because they feel the same when they are off the meds. Especially in silent cases like hypertension, diabetes where symptoms only appear when there are complications.
It is difficult to impose compliance when patients do not understand the implications of the disease in long run.
One more reason why patient don’t take their medication: The poor patient sold the medication away for $$ because some of the medicines from the gov clinic are so expensive!